HCV Treatment Flashcards
Sofosbuvir MoA
Nucleotide NS5B polymerase inhibitor
SofosBuvir, NS5B
What genotypes does sofosbuvir treat?
1-4
Sofosbuvir dose
400mg PO QD (used as a backbone for therapies)
Sofosbuvir duration of treatment
Up to 48 weeks
Ledipasvir MoA
NS5A inhibitor
LedipAsvir (NS5A)
Sofosbuvir/ledipasvir indication (what genotypes)
Genotype 1 only (but also treats 4-6?)
Duration of treatment for sofosbuvir/ledipasvir (with and without cirrhosis)
12 weeks without cirrhosis
24 weeks with cirrhosis
CrCl requirement for sofosbuvir/ledipasvir
CrCl >30ml/min
Duration of treatment for sofosbuvir/ledipasvir when the patient has cirrhosis
24 weeks
Sofosbuvir/ledipasvir dosing
1 tab PO QD (90mg ledipasvir, 400mg sofosbuvir)
Sofosbuvir ADEs
Bradycardia with amiodarone, fatigue, HA, nausea
Velpatasvir MoA
NS5A protease inhibitor
Velpatasvir/Sofosbuvir indication (genotypes)
1-6
Velpatasvir/sofosbuvir dosing
100mg capsule of velpatasvir, 400mg of sofosbuvir QD
Duration of treatment for velpatasvir/sofosbuvir
12 weeks with or without cirrhosis
ADEs of velpatasvir/sofosbuvir
headache, fatigue
Glecaprevir/pibrentasvir indication (what genotypes)
1-6
Glecaprevir/pibrentasvir dosing
1 tab PO QD with food (100mg glecaprevir, 40mg pibrentasvir)
Duration of treatment for glecaprevir/pibrentasvir without cirrhosis
8 weeks
Duration of treatment for glecaprevir/pibrentasvir with cirrhosis
12 weeks
ADEs of glecaprevir/pibrentasvir
fatigue, headache
CIs for glecaprevir/pibrentasvir
Severe hepatic impairment, coadministration with atazanavir and rifampin
Elbasvir/grazoprevir indication (what genotypes)
1 with or without cirrhosis
4
Elbasvir/grazoprevir dosing
Grazoprevir 100mg, elbasvir 50mg
CIs to elbasvir/grazoprevir
Moderate-severe hepatic impairment (Child-Pugh B or C), OATP1B1/3 inhibitors, CYP3A inducers and efavirenz
ADEs to elbasvir/grazoprevir
fatigue, headache, nausea
Duration of treatment for elbasvir/grazoprevir for genotype 1 infection
12 weeks
CrCl Velpatasvir requirement
> 30ml/min
Duration of treatment for elbasvir/grazoprevir for patients with NS5A polymorphisms and ribavirin
16 weeks
Treatment of chronic HCV GT1A
GLE/PIB x8 weeks
VEL/SOF x12 weeks
LDV/SOF x12 weeks (8 weeks if no cirrhosis, non-Black, HIV and HCV RNA <6 million IU/ml)
Alternative treatment for GT1A
EBR/GZR x12 weeks without NS5A polymorphism
Treatment of GT1B
Same treatments as GT1A
Treatment of GT 2 and 3
GLE/PIB x8 weeks
VEL/SOF x12 weeks
Alternatives for GT3 treatment
VEL/SOF and RBV x12 weeks (cirrhosis, NS5A RAS Y93H)
VEL/VOX/SOF x12 weeks
Treatment of GT 4
GLE/PIB x8 weeks
VEL/SOF x12 weeks
LDV/SOF x12 weeks
EBR/GZR x12 weeks
Treatment of GT 5 and 6
GLE/PIB x8 weeks
VEL/SOF x12 weeks
LDV/SOF x12 weeks
Treatment for patients with renal dysfunction (CrCl <30ml/min) with no cirrhosis and high urgency to treat with GT 1a, 1b, and 4
EBR/GZR x12 weeks
Treatment for patients with renal dysfunction (CrCl <30ml/min) with no cirrhosis and high urgency to treat with GTs 1-6
GLE/PIB for 8-16 weeks
Drug efficacy/monitoring: 4 week mark
CBC, SCr, LFTs, HCV RNA
Stop therapy if >10x increase in ALT or <10x increase with evidence of decompensation
Repeat HCV RNA test at week 6 if positive
Drug efficacy/monitoring: 6 week mark
HCV RNA if positive at week 4
Stop therapy of 10-fold increase
Drug efficacy/monitoring: 12 week mark
TSH
Consider HCV and stop most therapies
Drug efficacy/monitoring: 24 weeks
HCV RNA, assess for SVR
Stop 16-week regimens and check SVR longer
